ABSTRACT
BACKGROUND: Cutaneous leishmaniasis (CL) has been an endemic disease in Aleppo, Syria for many decades. During the past 12 years, there was a clear increase in the overall incidence of the disease in the region. Treatment using intralesional method of antimonial compounds became ineffective in a considerable proportion of cases and more patients developed the chronic form of the disease. OBJECTIVES: To categorize chronic cutaneous leishmaniasis (CCL) into different subtypes that mimic a wide spectrum of skin diseases, and to analyse the cause of this increase in the incidence of the disease as a whole and of the chronic type in particular. METHODS: A total number of 6200 patients with CL were seen in our centre, among which 1880 were initially diagnosed with CCL. Inclusion criteria for CCL included CL for more than 1 year. The diagnosis of CCL was made based on the clinical presentation and a positive Giemsa smear test. Biopsies were performed whenever the Giemsa smear was negative. Patients who had immunosuppression due to a medical condition or intake of immunosuppressive medications were excluded. RESULTS: Of 1880 patients, 1750 patients fit the inclusion criteria. Based on the lesion morphology, three different types of CCL were defined, among which five subtypes were observed based on clinical pattern and distribution of lesions. The two most common types of CCL were the papulonodular and plaque forms. Around 80% of all CCL cases occurred in individuals under 16 years of age and the most common location was the face (88.6% of cases). CONCLUSIONS: CCL due to Leishmania tropica can mimic many other dermatological conditions which might lead to a delay in making the correct diagnosis resulting in increased resistance to treatment. We have illustrated eight different clinical presentations of CCL and their differential diagnoses to make physicians more aware of the atypical presentations of CCL. A new treatment plan is suggested for the high-risk group of acute cutaneous leishmaniasis patients to decrease the likelihood of progressing to chronicity.
Subject(s)
Leishmaniasis, Cutaneous/pathology , Adolescent , Adult , Aged , Child , Child, Preschool , Chronic Disease , Diagnosis, Differential , Female , Humans , Leishmaniasis, Cutaneous/diagnosis , Male , Middle Aged , Young AdultABSTRACT
Cutaneous leishmaniasis has been endemic in Aleppo, Syria, for generations. Recently there has been a clear increase in the incidence of the disease, and more patients have shown a lack of response to antimonials. We report the results of a survey, undertaken over the period 2-17 January 1995, at a general hospital in Aleppo, of all patients presenting with cutaneous leishmaniasis. Patients were grouped according to the stage of their disease, and surgical biopsies were carried out for histopathological investigation. Patients who were unresponsive to treatment and proceeded to chronicity were predominantly children aged under 15 years with facial lesions. Histopathological examination showed that the inflammatory changes had reached the upper layers of the subcutaneous tissues in 10 of the 25 chronic cases (40%) and three of the four acute cases (75%). These levels of the skin are not directly reached by the antimonials administered intralesionally. The inadequacy of the intralesional method alone and technical errors in administration are discussed.
Subject(s)
Endemic Diseases , Leishmaniasis, Cutaneous/epidemiology , Adolescent , Adult , Biopsy , Child , Child, Preschool , Chronic Disease , Humans , Infant , Leishmaniasis, Cutaneous/pathology , Leishmaniasis, Cutaneous/therapy , Population Surveillance , Syria/epidemiologyABSTRACT
In a randomized prospective trial N-methyl-glucamine antimoniate (Glucantime) and human recombinant interferon-gamma were infiltrated around lesions of cutaneous leishmaniasis caused by Leishmania tropica in Syria. A previous trial had shown that intradermal application of interferon-gamma promoted the healing of similar lesions in the study area. Twenty patients with 38 lesions received 1-3 ml Glucantime and 20 patients with 37 lesions received 25 micrograms of interferon-gamma intradermally once weekly for 5 consecutive weeks. While all lesions treated with Glucantime were free of parasites after the third injection, only 69% of those treated with interferon-gamma were parasitologically cured by week 10. Within 10 weeks, lesions treated with Glucantime healed completely in 29/38, and partially in 9/38, cases, whereas 1/37 and 13/37 lesions treated with interferon-gamma healed completely and partially, respectively. Perilesional application of Glucantime was highly effective and superior to interferon-gamma for treatment of cutaneous leishmaniasis caused by L. tropica.
Subject(s)
Antiprotozoal Agents/administration & dosage , Interferon-gamma/administration & dosage , Leishmaniasis/drug therapy , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage , Administration, Cutaneous , Adolescent , Adult , Female , Humans , Immunoglobulins/analysis , Injections/adverse effects , Leishmaniasis/immunology , Male , Meglumine Antimoniate , Pain/etiology , Recombinant ProteinsABSTRACT
The clinical and immunological evolution of lesions in cutaneous leishmaniasis was assessed after treatment with human recombinant gamma interferon (rIFN-gamma). 3 weeks after rIFN-gamma treatment of lesions due to Leishmania braziliensis guyanensis, 12/13 had become smaller compared with 6/13 control lesions; only 4 treated lesions were free of parasites. 9 of 13 L tropica lesions treated with rIFN-gamma resolved completely within 4-8 weeks of treatment. An acute inflammatory reaction around treated lesions was more common in lesions due to L tropica. There were no other local or systemic adverse reactions. Histological and immunohistochemical studies indicate that local application of rIFN-gamma enhances cell-mediated immune responses and thus promotes healing of cutaneous leishmaniasis.
